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NPI Code Detail

MEDICARE: MRS. SUSAN B. GAIN APRN-BC, PNP

MEDICARE: MRS. SUSAN B. GAIN APRN-BC, PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerARNP2953602FL
2363L00000XNurse Practitioner13768TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477552347
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN B. GAIN APRN-BC, PNP
Provider Business Mailing Address
First Line : PO BOX 11503
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37401-2503
Country : US
Telephone Number : 423-778-3274
Fax Number : 423-778-2255
Provider Business Practice Location Address
First Line : 910 BLACKFORD STREET
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37403-1405
Country : US
Telephone Number : 423-778-6476
Fax Number : 423-778-4232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 10/07/2010

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